Agenda 10/25/2011 Item #10A10125/2011 Item 10.A.
Recommendurion W grant a C sate of Public Coave rime¢ and Necessity for inter - facility
embulerce transpros an Ambitrans Medical TrmispoM Inc., and authorize the County Manger,
in advertise and bring back for 1111311¢ mmideration an amevdmmt in Ordinevce No. 04 -12, as
amended, relating to ambulance and advanced He support services, for the pmpoae of revising
sections pertaining w Class 2 operators (posMmsphal ime -f ''lity medical ambula ce transfer
services).
OBJF,CT To pmcced in the bast interest of the public health, safety and wellbre by
granting a private provider a Cerlificere of Public Convenence and Necessity for wacent
Basic Life Support (BLS) aol Advanced Life Support (AU) inter - facility ambulance trmsporca
CUNSIDEBATION$: On September 26, 2011, Collar Cordy's Bureau of Emergarey
Services received an application from Avoidance Medial Trevaportation ins, dba, as Ambiaays
for a Certifimac of Public Cowmiewe and Necessity (COPCN) m provide Class 2 (post.
hospital inter- feclity medical transfer services) ambulance truuposurbas within C Jhff County.
Staff has reviewed the information and subsequeN recent correspondence fimn Ambilmm and
deed tba application complete.
It is tba opinion ofthe Bmeao ofFmergeucy Services then this service is necessary and Founded
an provide medical transportation services m patients being locations] Sum after, hospfial to
hospital, hospital to Mme, or hospital a nursing borne. Presently out ofcoudy medical
transportation services in the region are also provided by Ambivans. A COPCN is not required
for our of county transportation
Ambitrems is an experienced echo licensed provider by fie Store of Florida with offices and
services in Lee and Charlatan County and has it Own Medical Director coal hnsport pro excels.
If the OOPCN is approved, Collier County will not be responsible Por my reimbmaement or
subsidy provided by this service.
According Ambitrens's applcado%it can begin services in Collier County on January 9, 2012
with persotnel and vcltdes based and roving into Collar County from Cape Coal. Ambit am
has indicmM tbah desire m have pereomnel cod vehicles based in Colfier County when suitable
facilities are loaned. Ambitmos operates a 24hour -;-day dispatch center to Condense: County
ant lien radio comet[ with ib vehicles dryloyed nt Colin County. ff the COPCN s approved,
Ambitrevs will be acquired M work closely with Collier County EMS, Collier County Shortly
911 dispaclo pemomnel, local licavacal factions; and orb= responders to eawre tour their entry,
into local ant regional imer•6cihty embulmce transportation is properly coodineted. Ambitrma
would further be required to wordimte it educational and nonsuch efforts to licansed facilities
closely ends Collin Comfy EMS b ensure the appropriateness of treatment and transport
Additionally, coordinations of apennors behveen Ambitrena and Colin County EMS ant
Ambitmoa shall be conducted ur a miamm, of once every 90 days Ambiosm' dispatch cater
;call have day-to-day coerdimtim with Collier County EMS supervisory personnel to help
ensure adequate resources and communication
Packet Page -354-
10/252011 Item 10.A.
Ambitions shall ensure its full cooperation and timely response of any issues between its own
n Medical Director and the Collier County Medical Director to address any concerns in the
continuous oftenuent transport and Care.
Ordinance No. 04 -12, as amended, does not allow a Class 2 oppil or to make transports from
hospitals that it does not own and to have the own medical director. As such, Board direction is
needed to authorize the County Manager to advertise and bring back for fwure consideration an
amendment to Ordinance No. 04-12, as amended.
FISCAL IMPACT: Stiff estimates that 590 transports typically handled by Collier County
Emengenq Medical Services may be handled by Ambitions on nnual basis. This
redistribution of transports to Andetrans would result in an estimated annual net savings to the
EMS budget of $58,679, While this loss of tansports to Ambitions would denote an impact loss
of revenue to the County in the estimated amount of $213,500, there would also he an mutual
expenditure reduction of approximately $202,179 resulting from eliminating the need to deploy
the daily 12 how unit currently wilizcd to provide these transports. In addition, staff deems the
increase In emerg
ency vehicle availability for its core mission of pre - hospital care response,
treatment and transport worthy of this eAOrt.
GROWTH MANAGEMENT IMPACT: There is no Orowah Management Impact resulting
from this action.
LEGAL CONSIDERATIONS Ordinance NO. 04 -12, Section 7 states:
^ "The Board of county Commissioners shall not grant a certificate unless it shall find, after public
hearing and based on competent evidence that each of the following standards has been satisfied:
A. That there is a public necessity for the service. in making such determination, the Board
of County Commissions shall consider, as a minimum, the following factors:
(1) The extent to which the proposed Mouse is needed to improve the overall
Emergency Medical Services (EMS) capabilities of the County.
(2) The effect of the proposed service on existing services with respect to quality of
service and cost of service.
(3) The effect of the proposed service on the overall cost of EMS service in the
County.
(4) The effect of the proposed service on existing hospitals and other health care
facilities.
(5) The ef£ttt of the proposed service on personnel of existing serd ices and the
availability of sufficient qualified personnel in the local area to adequately staff
all existing services
B. That the applicant has sufficient knowledge and experience to properly operate the
proposed service.
C That, ifapplicable,there is an adequate revenue base for the proposed service.
D- That the proposed service will have sufficient personnel and equipment to adequately
cover the proposed service area."
Ordinance No, 04 -12, Section 8 provides:
Packet Page -355-
10/25/2011 Item 10.A.
"In making the determinations provided for in Section ] above, the Board may, in its sole
distinction, appoint a Hearing Officer b hold a public hearing and tc make factual findings and
conclusions as a result of the Fearing. Should a Hearing Officer be appointed, said Hearing
Officer shall render a women report to the Board within 30 days of the hearing, which report
shall contain the officeiss findings and conclusions of fact, and a recommended order. The
findings and conclusions of fact shall be binding upon the Board, but the recommended order
shall be advisory only."
A army 'of the application is included with this Executive Summarv. Copies of staffresponse and
Protocols are available for examination in the office of the Board of County Commissioners.
This Item Is legally sufficient and requires a majority vote. -JB W
RECOMMENDATION: That the Board of County Commissioners:
1. Approve the Certificate of Public Convenience and Necessity for Ambitions Medical
Transport, Inc.
2. Authorize the Chairman to execute the Permit and Cenificam;
3. Authorize the Counry Manager to advertise and bring back for future consideration an
amendment m Ordinance No 04 -12, as amended; our
4. Approve a Budget Amendment o recognize and appropriate the $250 annual renewal fee.
PREPARED BY: Dan Summers, Direclog Bureau of Emergency Services
Packet Page -356-
10125/2011 Item 10.A.
COLLIER COUNTY
Board of County commissioners
Rem Number: 10A,
Item Summary: Recommendation to grant a Certificate of Public Convenience and
Necessityfor inter facility ambulance transports to Ambitrans Medical Transport, Inc., and
authorize the County Manager to advertise and bring back for future consideration an
amendment to Ordinance No. 0412, as amended, relating to ambulance and advanced life
support services, for the purpose of revising sections pertaining to Class 2 operators (post
-
hospital inter - facility medical ambulance transfer services(. (Dan Summers, Director, Bureau of
Emergency Services(
Meeting Date: 10/25/2011
Prepared By
Name: BmckMarv2o
Title: Executive Secretary to County Manager, CMO
10/19/2011 12:13:25 PM
Submitted by
Ti ie: Executive Sccrelery to County Manager, CMO
Name'. BrockMi
10/19/2011 12:132] PM
Approved By
None'OchsL o
Title: Cowry Manager
Date: 10/19201115721 PM
Packet Page -357 -
10/25/2011 Item 10.A.
ATTACHMENT W
AMBITRANS MEDICAL TRANSPORT, INC.
Name
VehM1mu
WR
35HA65B45
mtt(ALS)
13135
V1 1901
m ttRV)
]3132
V31
U19
1FDSSW16n8196.593
Veal Permit (A15)
13W
31
45)3172
Vehicle ParrnB (AC)
13952
uP /2006
m d (As)
3117/2008 3117/2008
2F6Fx3 oBV531]
rml (ALE)
2494
4p /0009
90A59R0
ViR111, Plihinlit (AL5)
15539
6/26/2009
enlde PVmll(AIS)
13322
2/1512010
FPS53B6A0A3120a
Vehicle Perinit (AI-E)
15423
2/15/0010
IMSES3ES480i
Vehicle emlt(AIS)
16462
212412011
m .11aLL )
1653
2/24/2011
09GSEEl 11 023
mit(A1 )
116555
41412611
1 2
mn(A�)
tCcac
4/4/2011
m553a J HB2]334
10(azS)
3926
12/7/2005
B19658
VeNi Rill( 5)
3945
312162026
5534v96oB41e53
Vehicle rma(eLS)
LEA
3/2B/ x051
wE35F92171744]9)
Vehicle I¢(S)
4123
121191200]
16(8B15)
2/11/2006
aYXB9W31
Vehicle rmiE(BIS)
414
9132
7117/2008
Ye 54092
Vehicle he"nar,
o12Q
4/21m09
1FDSS3e5ADl
,Pe es)
Vehicle rma(BLS)
4333
21192010
5EES3BD >4x95
41p
7/1212010
1F0553E53Bw26ll5
i(BIS)
Vehicle PermPS (825)
9355
2124/2011
Packet Page -358
10/25/2011 Item 10.A.
Ali
r
4351 Pinnacle Street
Charlotte Harbor, FL 33980
AMBITWS (941) 743 -3665 • Fax (941) 829 -7314
September 26, 2011
Walter Kopka
Acting EMS Chief
Collier County EMS
8075 Lely Cultural Parkway
Suite 267
Naples, FL 34113
Re: COPCN Application
Dear Chief Kopkis
^ Ambitrana Medical Transport, Inc. (Ambitions) is pleased to submit the enclosed application to Collier
County for its consideration in the issuance of a Class 2 Certificate of Public Convenience and
Necessity ( COPCN) to provide ambulance transportation within Collier County.
Since 1995, Amle cans has specialized in the transportation of inter - facility transports by ambulance.
With our vehicles licensed and permitted through the State of Florida's Bureau of EMS, our fleet of
advanced life support and basic life support ambulances serve Southwest Florida on a daily basis.
Transports from hospital to hospital, hospital to nursing homes and nursing homes to hospital'
continues to represent our core business. While Ambitrans is proud to work in conjunction with EMS
organizations in Sarasota and Charlotte counties to mitigate their response to non - emergent calk for
assistance, our company focus remains committal to sarvicing the non -911 mallet.
For the last six (6) years, Ambitrena has been rendering Basic Life Support, Advanced Life Support
and Critical Care Transport to the Physicians Regional Healthcare System and the NCH Healthcare
' Transition fmm nursing homey to hospitals are non life threatening in nature
Charlotte County • Lee County • Sarasota County
www.ambitrans.com
Packet Page 359.
10/25/2011 Item 10.A.
Page Two
Chief Kopka ^
Collier County COPCN
System who required service to facilities located outside of the county limits. These out -of -county,
transports typically average over 60 miles in distance.
Ambitrans operates twenty -four hours par day, seven days per weak. Requests for transportation
are received through our Communications Center housed in our corporate offices in Pod Charlotte
wind our personnel and vehicles deployed from our satellite locations in Cape Coral, Pod Charlotte,
Venice and Sarasota. While we currently do not have a substation located within Collier County, we
are exploring our real estate options within the region.
In the absence of a formal COPCN application, items outlined in Section 50 -55 of the Collier County
Ordinance have been addressed within the contents of this binder as well as other material we felt
were of importance in your decision making process.
We welcome the opportunity for staff to conduct an on -site review of our premises and meet the
personnel who are responsible for making us the quality organization that we are.
Upon reviewing the enclosed information, should you have any further questions, please do not ^
hesitate to contact me at (S41) 613 -6427.
Sincerely,
Alan J vroneci
Chief Operating Officer
AJS: tons
Charlotte County • Lee County • Sarasota County ^
www.ambitmns.com
Packet Page -360-
10/25/2011 Item 10.A.
4351 Pinnacle Street
Chadotte Harbor, FL 33860
AMBITROS (941) 743 -3965 • Fax: (841) 626 -7314
October 13, 2011
Dan E. Summers
Director, Bureau of Emergency Medical Services
Collier County
8075 Lely Cultural Pkwy.
Suite 445
Naples, FL 34413
Dear Mr, Summem
Thank you for the opportunity to meet with you and Chief Kopko to review our COPCN
application. During our discumlon, the following questions were ralsed, which needed
9difi l clarification:
1) How soon will Ambltrans be able to provide a base of operations within
Collier County?
It is the goal of our company to secure a location as quickly as possible to coincide
with the commencement of operations in January 2012, There Is a possibility that
zoning requirements and parking accommodations may lead to unexpected delays.
2) What is Ambltrans policy on collecting payment at the time of service?
Ambitrans requires payment at the time of service prior to transporting an individual
for a non - covered service; this includes physician or patient preference. Payment Is
expected at the time of service when the patient's destination Is greater than 50
miles.
Charlotte County • Lee County • seasons County
www.ambitans.com
Packet Page 361-
10/25/2011 Item 10.A.
Page Two
Dan E. Summers
The preceding does not apply when Ambitrans has received prior approval from the
patients insurance company authorizing transportation.
3) Would Collier County have any financial obligation to Ambitrans for any
services rendered]
The issuance of a Certificate of Public Convenience and Necessity by Colllet-County
to Ambitrans Medical Transport, Inc. in no way obligates Collier County financially
for any services rendered by Amateurs.
Ambitrans wants to work with Collier County EMS to Inform the healthcare community
about our role within the system. Our goal is to introduce Ambitrans to the healthcare
community using our Internal Community Relations Department, educating facilities an
the services and resources we offer.
1 hope the above provides you with the additional information you requested.
If I maybe of any further assistance, please do not hesitate to contact one at (941) 613-
642].
Sincerely,
614e 1�2
Alan ). Skavroneck
Chief Operating Officer
AIS: Jones
Chenone County • Lee county • Parasols county
w.vw.smbttrensoom
Packet Page 362-
10/25/2011 Item 10.A.
ADVANCED LIFE SUPPORT PROTOCOLS
Amblirana Metlical Transpor% Inc. and Venice Ambulance Service, Inc.
EFFECTIVE Auaust 1.2010
THIS DOCUMENT CONTAINS THE ADVANCED LIFE SUPPORT TREATMENT
PROTOCOLS OF AMBITRANS MEDICAL TRANSPORT, INC. AND VENICE
AMBULANCE SERVICE, INC. PURSUANT TO CHAPTER 64J- 2.0W(4)(b) FLORIDA
ADMINISTRATIVE CODE.
THESE PROTOCOLS ARE IMPLEMENTED UNDER THE DIRECTION OF
MATT WEISINGER, M.D., MEDICAL DIRECTOR OF AMBITRANS MEDICAL
TRANSPORT, INC. AND VENICE AMBULANCE SERVICE, INC. AND SUPERSEDES
ALL PREVIOUS TREATMENT PROTOCOLS,
THIS DOCUMENT SHALL REMAIN IN EFFECT UNTIL REVOKED OR REVISED, IN
WRITING, BY THE MEDICAL DIRECTOR OF AMBITRANS MEDICAL TRANSPORT,
INC. AND VENICE AMBULANCE SERVICE, INC.
Melt M.D.
MEDICAAL L DIRECTOR
CTOR
Amblirana Medical Transport, Inc. and Venice Ambulance Service, Inc.
NOVEMBER 1, 1992
MAW 08110 eRective 0810IJ2010
198
Packet Page-36a-
10/25/2011 Item 10.A.
Ambitrans Medical Transport, Inc. - Collier COPCN Application
Sec. 5055 procedure for obtaining cetlMCate.
An applicant fora Cardinale shall obtain tons tram the department to be completed and
resumed to Me division administrator. Each application shall contain:
(1) the name, age and address of the owner of the ambulance or ALS provider, or
if the owner is a corporation, than of me directors a the corporation and of all
of the stockholders holding more than T5 percent of Me outstanding shares.
For governmental units, Mis information shall be supplied for members of Me
governing body.
Michael J.
Grant, 4351 Pinnacle Street, Charlotte Harbor, FL
33880
50%
Lorraine B.
Grant, 4351 Pinnacle Street, Charlotte Harbor, FL
33980
500A
Packet Page 3"-
vions bi Big - 1tepatlnlent of Stele 10/25/2011 Item 10.A.
Home Cooled, E Filing Earn..e Meal farms Help
Pre%lns on List Ned on List Retain To List Enllly Name Sea"
No foal No Name History Sobmtl
Detail by Entity Name
MEDICAL TRANSPORT, INB.
FEVEIN Samara U0571130
One Filed "271100
Stele FL
Sptlu ACTIVE
Effective Whe 0=11IN5
Principal Address
1351 PINNACLE STREET
:MARLOTTE HARBOR FL 33OW US
;Ion"" 04MIA2003
Nailing Address
1351 PINNACLESTREET
:HARLOTTE HARBOR FL 33080 US
;nsnasd 04mv2ooa
Registered Anent Name & Address
3RANT, MICHAEL
1351 PINNACLE STREET
:HARLOTTE HARBOR FL 33M US
Name B Address
Report Year Filed Dote
Packet Page 365 -
hnp: / /ww ..suiibiz.org/ scripts /cordet.exe ?action= D=ILkinq_dBc number-P95000132,18... 9/26,120 11
www.suabiz.mg- Department of State 10/25/2011 Item 10 A.
2W8 NoWa00
2m0 OM112010
2011 o"Wotl
t - ANNUAL REPORT
OWIM10 -ANNUAL PORT
04POW009 REPORT
04162000- ANNUALREPORT
04242007 - ANNUALREPORT
N 202000- ANNUALREPORT
04/16a0 05 .. ANNU LL REPORT
0210200U, ANNUAL PORT
ORIR REPORT
0412212002 - ANNUAL REPORT
01V 41200 - ANNUALREPORT
05YL -ANNUALREPORT
NADWlM REPORT
0412211980 - ANNUAL REPORT
0211711997 - ANNUAL REPORT
Da(2711905 DOCUMENTS R TO 99]
Preobus on L IS Next onLLSt Return To Ll EnUl Name 50alU
No EVanle No Name HMtOry SubmR
I Home I amen m 10.t.eOl seamrts I s elan senxes I TOMS I xao I
Packet Page -366-
http:/ /www.sunbiz.orgtwripts
/wWet.exe ?action— DEL'PIL&inL doc_nunl
erJ?950000218...
9262011
10/25/2011 Item 10.A.
Ambitrans Medical Transport, Inc. - Collier COPCN Application
(1) The boundaries of Me territory desired to be served.
Collier County
Packet Page -36T-
10/25/2011 Item 10.A.
Ambitrans Medical Transport, Inc. - Collier COPCN Application
(3) The number and brief description of the ambulances or other vehicles the
applicant will have available.
summers currently has sixteen (18) vehicles available to He fleet These units are
permitted with the Bureau of EMS as Advanced! Life Support and Basic Life Support
ambulances.
Through the use of the company's computer aided dispatch software, Zoll Data
Rescui Dispatch - Billing`s, management is able to staff according to anticipated
demand Staffing levels and farmers are determined using historical data and Other
internal statistics. Vehicles are posted in accordance with direction from our
communications center personnel to specified areas to aid In proper deployment and
call response.
In the event of increased call volume, Ambitrans has the ability to schedule additional
labor and resources to meat any unforeseen increase in market demand.
Packet Page 368-
10/25/2011 Item 10.A.
Ambitrans Medical Transport, Inc. - Collier COPCN Application
(a) nine sadness of Me trended headquarters and any substations.
Ambitians corporate office is located at:
4351 Pinnacle Street, Port Charlotte, FL 33900
Our Closest substation to Collier County Is located at
935 N.E. T" Terrace, Cape Coral, FL
Ambi cans is in the process of sak u in9 services of local real estate professionals to
aid in the search of properties within Collier County, to provide proper
accommodations of our vehicles and personal. Until a location is determined,
Ambitrens staff and ambulances will continue to be deployed from our Lae County
sub station.
Packet Page 369-
10/25/2011 Item 10.A.
Ambitrans Medical Transport, Inc. - Collier Cl Application
(5) The handling and experience bill applicant.
Ambitrans Medical Transport, Inc. was Incorporated in 1983 to provide Para transit
services to the residents of Charotte County . In 1988, ownership of the company
transferred to its current principals. In 1995, Ambitrans commenced Its ambulance
operations.
Today, Ambitrans operates in Sarasota, Chil and Lee counties. On occasion, in
accordance with Collier County ordinance 501 (4), Ambitrans has been celled to
transfer patients from acute care facilities to destinations outside of Collier County.
Ambilrans is compliant with Florida Stal 401 and Florida Administrative Code 64J
in accordance with standards set forth by the Bureau of EMS and Department of
Health as evidenced by the recent site inspection conducted by the Bureau. Our
state license is valid through August 2013.
As noted on our enclosed organizational chart, the management team at Ambbrans
collectively has over 200 years of experience in the EMS industry. We employ ^
personnel who are specifically assigned W our Training and Quality Assurance
Department Patient rare reports are reviewed for quality assurance and adherence
to our medical protocols and standards of care. Our education team is also
responsible for our in -house Uaintng. which Includes CPR, Advanced Cardiac Life
Suction, Pediatric Advanced Life Support, Emergency Vehicles Operators Course
and on -going Continuing education units headed for d- annual cealf action renewal.
Dr. Matthew Wasinger serves as our medical director of record as mandated under
Florida Statute 401.265. This is in addition to his normal day-toESy duties as an
emergency room physician at Peace River Medical Center in Port Charlotte.
Packet Page -3J0-
O
. j
L
O
CO
Q.
r
aq
Packet Page 371-
F9
10/25/2011 Item 10.A.
6 a
g2
g
e
age
��S
L
g6
0
aq
Packet Page 371-
F9
10/25/2011 Item 10.A.
6 a
g2
g
e
10/25/2011 Item 1 D.A.
Ambitrans Medical Transport, Inc. -Collier COPCN Application
(6) The name and addresses of Three Collier County residents who will act as
references for We applicant.
Pseudo Davis
212 Napa Ridge Road East
Naples, FL 34119
Representative Matt Hudson
3301 East TamieniTail
Naples, FL 34112
Senator Garrett Richter
2320 Hamer Run
Naples, FL 34105
Packet Page -372 -
10/25/2011 Item 1 D.A.
Ambitrans Medical Transport, Inc. - Collier COPCN Application
(2) Aschedule o /rates which the service Intends to charge.
Packet Page 373
Basic Life Support Base Rate
$395.00
Advanced Life Support Base Rate
$395.00
Advanced Life Support Base Rate — Level 2
$525.00
Specialty Care Transport Base Rate
$75000
Per Loaded Mile
$1000
Oxygen
$45.00
Drugs
$10.00- $25.00
V SupPlles
$20.00 - $25.00
Packet Page 373
10/25/2011 Item 10.A.
Ambitrans Medical Transport, Inc. — Collier COPCN Application
(a) Such oMerpoduem eh rmtlion as We adminuerafor may require.
No additional Information was requested by the administrator at the time of
submission
Packet Page -3)a-
10/25/2011 Item IO.A.
Ambitrans Medical Transport, Inc. - Collier COPCN Application
(9) An app 117e0on Or "newel fee of $250.00. (Ercepfion Collier County EMS).
See next page for copy of check.
Packet Page 375-
!
�p
�}
,
Packm Page 376
10/25/2011 Item I O.A.
%\
[:
\
/d\
§
\U
\�
\/
Packm Page 376
10/25/2011 Item I O.A.
10/25/2011 Item 10.A.
Ambitrans Medical Transport, Inc. - Collier COPCN Application
(10) Financial data Including assets and liabilities of the operator. Aschodule
of all debts encumbering any equipment shall be Included.
See nerd page for financial inlamefion.
Packet Page -3>)-
10/25/2011 Item 10.A.
AMBITRANS MEDICAL TRANSPORT, INC.
FINANCIAL STATEMENT
June 30, 2011
Packet Page -3J8-
10/25/2011 Item 10.A,
INDEPENDENT ACCOUNTANTS' COMPILATION REPORT
To the Beard of Directors;
Andaman Medical Transport, Inc.
Pon Cloolode, Florida
We have compiled the accompanying statement of assets and liabilities of the ambulance
trimporlation operations oP Ambitraos Medical Fireman, Inc. and subsidiaries as of June 30,
2011. This financial statement has been prepared on the income basis of accounting noticed by
the C olpnrry f @deal income tax reporting pompous, We have not audited or reviewed the
companying financial statement and, accordingly, de nor express an opinion or provide any
e about whether the financial statement is in accordance with the income tax basis of
accounting.
Management is responsible for the preparation and fair presentation of the financial sentenced in
accordance with the income tax basis of accounting and for designing, implementing, and
maintaining internal control relevant to the preparation and fair presentation of the financial
statement
Our responsibility is m conduct the wmpilafion in accordance with Statements w Standards for
Accounting and Review Services issued by the American Institute of Certified Public
Accountants The objective or a compilation is to assist management in presenting financial
information in the form of a financial sfatemen without undertaking Be obtain or provide any
assurance that there ma no materiel modifcatiom that should be made to (he financial statement.
The accompanying statement was prepnrcd fo the purpose of presenting the assets and liabilities
of the ambulance traneponation operations ofAmbitans Medical Transport, No and subsidiaries,
and is not intended to be a complete presentation of Ambitram Medical Trampert, Inc. and
subsidiaries consolidated assets and liabilities.
This report is intended solely for the information and use of the board of directors and
anagement of Ambitrans Medical Transport, June, and NI Collier County Board of County
Commissioners and is not intended to and should not be used by anyone other than deem
specified parties.
September 26, 2011
Punts Gorda, Florida
201WAGAIWAIENUg6UOT1202 PImmACOn FL]3950 C(OVOOMB6291197 AAXINNU629d299
Packet Page 379-
BRIAN W. CROSLAND, CPA, PL
CERTIFIED PUBLIC ACCOUNTING & CONSULTING
Baux Utm, CPA
-le,mi
ou A,CWr
INDEPENDENT ACCOUNTANTS' COMPILATION REPORT
To the Beard of Directors;
Andaman Medical Transport, Inc.
Pon Cloolode, Florida
We have compiled the accompanying statement of assets and liabilities of the ambulance
trimporlation operations oP Ambitraos Medical Fireman, Inc. and subsidiaries as of June 30,
2011. This financial statement has been prepared on the income basis of accounting noticed by
the C olpnrry f @deal income tax reporting pompous, We have not audited or reviewed the
companying financial statement and, accordingly, de nor express an opinion or provide any
e about whether the financial statement is in accordance with the income tax basis of
accounting.
Management is responsible for the preparation and fair presentation of the financial sentenced in
accordance with the income tax basis of accounting and for designing, implementing, and
maintaining internal control relevant to the preparation and fair presentation of the financial
statement
Our responsibility is m conduct the wmpilafion in accordance with Statements w Standards for
Accounting and Review Services issued by the American Institute of Certified Public
Accountants The objective or a compilation is to assist management in presenting financial
information in the form of a financial sfatemen without undertaking Be obtain or provide any
assurance that there ma no materiel modifcatiom that should be made to (he financial statement.
The accompanying statement was prepnrcd fo the purpose of presenting the assets and liabilities
of the ambulance traneponation operations ofAmbitans Medical Transport, No and subsidiaries,
and is not intended to be a complete presentation of Ambitram Medical Trampert, Inc. and
subsidiaries consolidated assets and liabilities.
This report is intended solely for the information and use of the board of directors and
anagement of Ambitrans Medical Transport, June, and NI Collier County Board of County
Commissioners and is not intended to and should not be used by anyone other than deem
specified parties.
September 26, 2011
Punts Gorda, Florida
201WAGAIWAIENUg6UOT1202 PImmACOn FL]3950 C(OVOOMB6291197 AAXINNU629d299
Packet Page 379-
I
10/25/2011 Item 1C.A.
Ambltrans Medical Transport, Inc. and Subsidiaries
Statement of Assets and Liabilities of the Ambulance Transportation Operations
(umanited)
gasem
CementA.aah
Caab avallable for
ambulance ae mporlalion operatbns
Pro M and d Eanumm ll
O(fim equipment and computers
Machinery and equipment
Medical" criminal vehIclas
Less accumulated deprearamn
PmpeM1y and Equipment, net
Total Assets
Liabilities
Current L'ab'ftes
Accrued prole sharing
Other Pal
Notes payable to wake
Who Term Looking; e
Notes payable to banks
Less current portion above
Tole) lieblllllea
Net Assets Over Liabilities, Income tax band
Read Independent Accournal Complla ion Report
Packet Page 380
$375.000
65.058
85.518
915.134
1.065,710
(872075)
193,535
8588635
$143,161
31572
65.612
240,346
142.379
(65.512)
76,767
317,112
$251523
10/25/2011 Item 10.A.
Ambitrans Medical Transport, Inc. - Collier COPCN Application
As outlined in Collier County ordinance Sec. 50 -62 (2)(b), Ambltrans Medical Transport ,
Inc. is applying for a Class 2 certifcate. However, the description within the ordinance is as
follows:
°Class 2 -ALS transfer clef imcate holders may provide pasMackmad lntetlecfldy, medical
Imnsrer similarly and romine ALS and BLS calls within the county but only to hospitals owned
by did pegboard holder however, the Class 2 pegboard holder may provide out- m -couny
IMOSINGd. Unless an EMS provMer possesses a Class 1 -ALS Rescue certilicate issued by the
county, a c9chiibli of public convenience sntl necessity must be obtained from the county
before engaging in this level ofinedicalse scat
Ambiters is not a hospital based or owned entity. Our goal Is to provide ambulance
served to those facilities in need of inter- facilily service as well as the ground transportation of
patients who no longer require the services belieived in an acute care selling and disdrarged
from the hospital, as well as services to nursing home where their residents require
a transportation in a thin emergency cell" status. This may be for services that are not available
within nursing homes (i.e. Mi dialysis, wound care.)
Ambitions contracts with Dr. Mathew Wiesinger, M.D. for medical services as required
in Florida Stable 401 265. His responsibilities to Ambhrans are similar to those outlined in
Collier County Ordinance 50- 62(2)(c),
Packet Page -381-
10/25/2011 Item 10.A.
_ DP ID: At
'9` RORO CERTIFICATE OF LIABILITY INSURANCE noenwn
THAN CERTIFICATE IB IMBUED AT A1M9ER OF INFORMAHROX ONLY AND CONFERS NORMXIB UPOR THE OERTFICATE XOLOEfl.lX10
.ERTFlWTE DOER NOT AFFMRABVELV OR NEOAITOLV END, EXTEND OR ALTER THE COVEMOE AFFORDED BY TRUE PMIOU
NE M71RCAU OF INSURANCE WE M
RE NOT CONSTITUTE A COMCT BETWEEN THE IBWINO INSURERIM. AUTHORIZED
BELOW.
WT
HE
AXOTX CEMIFIOTENDWER.
M WAIVE
Rdur ban PODRWXPL IXEUPERD. M�pallbpyDn^mnl banBmM. If 6USPOct
iau to SAW
1111111" Illb SAI dn"
mylpu an o .Aebdnnnl onlMa «RIflo06on MOOnhr SSb 10 1N
wntlgonF 011Npolpy,aNln pellelu
corMluu holder In HoU of &AMLndomM d.
rnoou[u BN -8]] -0318
= .
KW.nN__ _ - 5n %r_ - -. _.._-
010 NMR ulSURAI BN'B3JJf3B _. I
So
n VAYe2 F ,ml ORANT B
ErtlnWl wExw_ wer
Fmpin Fl 6M tl Bn CO._ 31J38 _
uTan Gon,to fi IT apolaBon,
3830
AmbuleOU MpmtBarvlcae. LLL ma Am u O Mafl Lleblllq _
AmblhanS MATRIX TranspoR l _ -I -_ - -
VBMUAmbuIaMFBArvlca.lno.
4101 Plnnaele Blre t - _ NII
1
CbaNOXe HINm FLS]BBD
--
CWIRAOE9
OERiIFICARNUMBER:
REN NNUMBER:
NMIE PBORi WP iX7
THE W
PoLI PEWMo
THIS
IN TO CI THIS THE FORUE
DE INNAL
OF IT He WELEAN
USAT
MOMENT
P X
MY
COMMENT
WED
Is
TCAMe
METHODS
WRAY AN ISSUED OR
IM
6nx W
E
.q:
9 ux Aw
W
a
CL3170N
MONTH
NIA
Plpp ae:anca
10P00
Mae
A
% M
BA0
"w I %I om
I
Eww ,y
i0
A
% rclrµ
LL311800
Olglllt
q1M
_ AD.
. — -..
].WO.0
x I
1.DBmP.
-
T HE
x KY IF "° If«
C
u
I.W OAO.
u rm
A
wm
CL317885
Mgfill
MI11
um
_
MMI
% M)LUMOS
MASS
w owmr
xame
DauMa
x,dpDPD
ham. % 6Ln
apli
rm�
IADCEUpprDD
(PRIOR
arm
e
"aAI
X ql
poelwo IN
I'm
at MOTHASENT
I
NWAEMlIM
MR IFp1TE HOLOIP
CN"ER I ATIFYIN
FIARI.3
TAX ewimnON FIRM THEREOF, NOTICE A L Be oewellln
Florld,0000180011118"
ACnonoul NTXTXEFawYFRmnwxs.
arcYM^dlnXBervlw
AD,: BAMam FARM
p_e YMBL.
lSlid CAMARAMFVae 18
GSA
..,.,..,.r.R°rrR.HER. ARW Ma HMIMA.
ACORD 38 DMORM1 no ACORO ne ERr ACYRD
Packet Page - 382 -"d am
10/25/2011 Item 10.A.
Ridgefield Employers
Insurance Company.,,
Member or liberty >luonal Gran,
AS1 Ueuren Per See man- LeknImd. FL Me0S088a
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE
umw mm 31261
-- mow •.w., �aaa66sL
Item 1. meorea _
here Ambllrens Mealcal Tranquoglnc, alt In 091488436
uen 4 4351 Pinnacle Kraft
Puma Gorda, FL 33980 -2902 _ layout X Sort
mwMe _ewnwln'M
O111ar weriplac¢a not March abet,'. our
SEE EXTENSION OF INFORMATION PAGE rtix- 65-0 511130
Irem2. Pollcypenoe
From 12/21710 b 12127/11 akneadime al the eoere¢ccllbinm ma as Aalen hook
Item 3. C wags
Ae across come anaeson furniture: Pail One of the Poliry Ma lleab Na Wmkev COmPoneclun Law of the Mal" t ae
here: Flotlae
9. Empbyen GadlM remains Pen Two of 0, pollry apPlle¢ M work In seen Stale leafed In Item 3A The home of our
ILI IlkAIy ruder Pen 710 are 8cdly lmuraby ACCklenl te 11000.000 east emaent
9aally It by Oleeer. g 11000,000 men wrehar e
Bomly lnNtl byDoes" $ 1,0001000 Mron wall
C Other Stales Insurance : %eTmae of lne polwy appllwblM1a ¢later, ll any, lklaadaml
Alabama Arkansas Georges Kentucky Lowisiare MISSlsuppl North Carolina South Celolil Tenneaaee
0. Thu porky Moral these moseamenb and Schedules
kem4, Pnmlum
The remain br free poky will no aerem,lned by our Wnuale of Par", CleecMkarlore, Psba and PHNg Pans, All
Inbrmalbn required below 0 Sol b "Italian aid change Ma aWX.
Total E¢IImadd Annual Premium of
Minimum Pramem 5 i FapsnSe caused S
This point, Ifte lug all ensomeness Issued Sherwin. P hmelry
countermand by �� Ome 0928/10 _
^ 2242 Rumored lna28110
Its Oere Prepared O9rzelt0
acue�ur.ernwwaan Packet Page -383- ennu,a.n er...e.,rAA.aar�.„
after Mal
Me arena.
nue,"Sl
See Pastures Of Inforil noun
add
Total E¢IImadd Annual Premium of
Minimum Pramem 5 i FapsnSe caused S
This point, Ifte lug all ensomeness Issued Sherwin. P hmelry
countermand by �� Ome 0928/10 _
^ 2242 Rumored lna28110
Its Oere Prepared O9rzelt0
acue�ur.ernwwaan Packet Page -383- ennu,a.n er...e.,rAA.aar�.„
10/25/2011 Item 10.A.
R �4SMr
o wemor
HEALT.'. X. FmM ironic il.MD. FLU `
ammem¢wLoani
August 15, 2011
Mr. Nathaniel E. Cooley
Ambllam Medical Tanspo t, Inc.
0351 Pinnicle St.
Part Charlotte, Fl 339W
Dear Mr. Cooley
Congratulations on your outstanding Comptance Monitoring site survey conducted by the
Bureau of Emergency Medical Services on August 10. 2011. We found no deficiencies during
our site survey. Your vehicles and service records were outstanding. Thank you for being
role modal of excellence as an EMS presider in the state of Florida.
Also, Meese extend my sincere gratitude to your staff far their assistance and for the overall
contrimmon to your service and community. Your continued support of emergency medical
services is deeply appreciated,
Endorsed is a post site survey evaluation form assigned to assist us In continually Improving our
Compliance Monitaringprogam. Please complete the enclosed form and return it to my office
at your earliest convenience. I trust that you all share With me any concerns or kudos
regarding your site survey.
Again, thank you for your assistance In fire Compliance Monitoring program and I look forward
to hearing from You.
SincerelyA
John C. ter, Paramedic, RN, BSN
Chief. Bureau of EMS
JCBhmp
cc Matthew 1. Wlesinger, M.D., Medical Director
BureuorEm,g yMWktl$o-nm
4052 aW C}Wau Way. Ohl Cis - TaInfia eF I'll 3 1
Pare,085 024344H Pw: (850)966940e•M1nplMxw.Mems.mm
Packet Page -3M
10/25/2011 Item 10.A.
nnoa n
Gvvnnw
HL{ryL e LT KFlank Fxmvh MD i
OUR swarm Gains
August 15, 2011
Mr. Nathaniel E. Cooley
Venice Ambulance Service, Inc
6351 Pinnicle St.
Poll Charlotte, Fit 33980
Dear Mr. Cooley.
Congratulations on your outstanding Compliance Monitoring site surrey conducted by the
Bureau of Emergency Medical Services on August 10, 2011. We found no defklenaies during
our site survey. Your includes and service records were outstanding. Thank you for being a
role model of assistance as an EMS Provider In the state of Florida.
Also, please Wand my sincere gratitude to your staff for their assistance and for the overall
contribution to your service and community. Your continued support of emergency medical
services is deeply appreciated.
Enclosed is a post site survey evaluation form designed to assist us in Cantimally improving cur
Compliance Monitoring program. Please complete the enclosed form and return it to my office
at your eedlest 0omen eoce. Itrust that you will share lNth me any Concerns or kudos
regarding your site survey.
Again, thank you for your assistance in the Compliance Monitoring program and l look forward
to hearing from you.
Sincerxrwaraerm;
John C�R
Chiaf,
JCelwnp
cc: Mat thew L. Worthier, M. O., Medical Director
False IF smart Metlknl svrvive
0032 FORM CyPrta Way, an, CIS - TeI1N¢i , Fall, 1239F.I738
Payne:aus) M}4414• Fu:(aW)989 A 0R•XnrylMww.e.Xm,mm
Packet Page 385-
10/25/2011 Item 1O.A.
/ \ ]
- \\ ` `- {
§ §§( z %| / )
\ ! \ ) :
:!! .; !;§
h §�§
\ )
§` ) if ;
(
{ / ]
} i` ,
Packet Page -386
PO
10/2512011 Item 1O.A.
`
§)
g
\
\§
:
�
-
!)
§
`
X20
)!|
/
/
\ \�
G{
`
/ §
§o `
®
)!,
.
,f
!
\
§
-
�
\\
}_
!)